Background:Recently, the analysis of dietary patterns has emerged as a possible approach to examining diet-disease relations. Objective: We examined the reproducibility and validity of dietary patterns defined by factor analysis using dietary data collected with a food-frequency questionnaire (FFQ). Design: We enrolled a subsample of men (n = 127) from the Health Professionals Follow-up Study in a diet-validation study in 1986. A 131-item FFQ was administered twice, 1 y apart, and two 1-wk diet records and blood samples were collected during this 1-y interval. Results: Using factor analysis, we identified 2 major eating patterns, which were qualitatively similar across the 2 FFQs and the diet records. The first factor, the prudent dietary pattern, was characterized by a high intake of vegetables, fruit, legumes, whole grains, and fish and other seafood, whereas the second factor, the Western pattern, was characterized by a high intake of processed meat, red meat, butter, high-fat dairy products, eggs, and refined grains. The reliability correlations for the factor scores between the 2 FFQs were 0.70 for the prudent pattern and 0.67 for the Western pattern. The correlations (corrected for week-to-week variation in diet records) between the 2 FFQs and diet records ranged from 0.45 to 0.74 for the 2 patterns. In addition, the correlations between the factor scores and nutrient intakes and plasma concentrations of biomarkers were in the expected direction. Conclusions: These data indicate reasonable reproducibility and validity of the major dietary patterns defined by factor analysis with data from an FFQ.Am J Clin Nutr 1999;69:243-9. KEY WORDSDiet, dietary pattern, factor analysis, biomarker, reproducibility, validity, men, Health Professionals Follow-up Study, food-frequency questionnaire INTRODUCTIONTraditional analyses in nutritional epidemiology typically examine diseases in relation to a single or a few nutrients or foods. However, people do not eat isolated nutrients. Instead, they eat meals consisting of a variety of foods with complex combinations of nutrients. The single-nutrient approach may be inadequate for taking into account complicated interactions among nutrients in studies of free-living people (eg, enhanced iron absorption in the presence of vitamin C) (1). Also, the high level of intercorrelation among some nutrients (such as potassium and magnesium) makes it difficult to examine their effects separately (2). Moreover, because nutrient intakes are commonly associated with certain dietary patterns (3, 4), single-nutrient analysis may be confounded by the effect of dietary patterns (5).To overcome these limitations, several authors recently proposed to study overall dietary patterns by considering how foods and nutrients are consumed in combination (4, 6-13). In a dietary pattern analysis, the collinearity of nutrients and foods can be used to advantage because patterns are characterized on the basis of habitual food consumption. Examination of dietary patterns would more closely parallel ...

The AHEI predicted chronic disease risk better than did the RFS (or the HEI, in our previous research) primarily because of a strong inverse association with CVD. Dietary guidelines can be improved by providing more specific and comprehensive advice.

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BACKGROUND The disease risks from cigarette smoking increased in the United States over most of the 20th century, first among male smokers and later among female smokers. Whether these risks have continued to increase during the past 20 years is unclear. METHODS We measured temporal trends in mortality across three time periods (1959–1965, 1982–1988, and 2000–2010), comparing absolute and relative risks according to sex and self-reported smoking status in two historical cohort studies and in five pooled contemporary cohort studies, among participants who became 55 years of age or older during follow-up. RESULTS For women who were current smokers, as compared with women who had never smoked, the relative risks of death from lung cancer were 2.73, 12.65, and 25.66 in the 1960s, 1980s, and contemporary cohorts, respectively; corresponding relative risks for male current smokers, as compared with men who had never smoked, were 12.22, 23.81, and 24.97. In the contemporary cohorts, male and female current smokers also had similar relative risks for death from chronic obstructive pulmonary disease (COPD) (25.61 for men and 22.35 for women), ischemic heart disease (2.50 for men and 2.86 for women), any type of stroke (1.92 for men and 2.10 for women), and all causes combined (2.80 for men and 2.76 for women). Mortality from COPD among male smokers continued to increase in the contemporary cohorts in nearly all the age groups represented in the study and within each stratum of duration and intensity of smoking. Among men 55 to 74 years of age and women 60 to 74 years of age, all-cause mortality was at least three times as high among current smokers as among those who had never smoked. Smoking cessation at any age dramatically reduced death rates. CONCLUSIONS The risk of death from cigarette smoking continues to increase among women and the increased risks are now nearly identical for men and women, as compared with persons who have never smoked. Among men, the risks associated with smoking have plateaued at the high levels seen in the 1980s, except for a continuing, unexplained increase in mortality from COPD.